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NPI Code Detail

MEDICARE: DR. LAROY PETE PENIX M.D.

MEDICARE: DR. LAROY PETE PENIX M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology Physician49080GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396837225
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAROY PETE PENIX M.D.
Provider Business Mailing Address
First Line : 1667 NISKEY LAKE RD SW
Second Line :
City : ATLANTA
State : GA
Zip : 30331-6401
Country : US
Telephone Number : 404-344-3142
Fax Number : 404-344-9263
Provider Business Practice Location Address
First Line : 1100 CLEVELAND AVE
Second Line : SUITE 100
City : EAST POINT
State : GA
Zip : 30344-3602
Country : US
Telephone Number : 404-766-4760
Fax Number : 404-766-4702
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2006
Last Update Date : 07/08/2007

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